<script type="text/javascript">
    {literal}   
    $(document).ready(function () {        
        
    });    
    {/literal}        
</script>
<table cellspacing="0" cellpadding="0" style='width: 100%;'>
        <tr>
            <td class='label'>
                {translate}Patient's ID{/translate}
            </td>
            <td>
                <input type="text" size="10" name="patientCode" value="" id="patientCode" />
            </td>
         </tr>
         <tr>   
            <td class='label'>{translate}Full name{/translate}</td>
            <td>
                <input type="text" size="30" name="patientName" value="" id="patientName" />&nbsp;&nbsp;&nbsp;&nbsp;
            </td>
        </tr>
        <tr>
            <td><span class='label'>{translate}Gender{/translate}&nbsp;&nbsp;</span></td>
            <td>
               <input id="male" type="radio" name="gender" value="male">{translate}Male{/translate}
               <input id="female" type="radio" name="gender" value="female">{translate}Female{/translate}
            </td>   
        </tr>        
</table>
